Put the Freeze on Hot Flashes

Hot flashes might be a topic played mostly for laughs ("Is it hot in here, or is it just me?"), but they’re a
serious matter for menopausal women plagued by sudden, overwhelming sensations of warmth
that leave them soaking wet and often embarrassed. The good news is that there
are more options than ever. Start with simple lifestyle changes, and if those
aren’t effective, work your way down the list.

“Your diet should consist of lots of fruits and vegetables,
plant-based proteins, lean meat and omega-3 fatty fish like salmon at least four
times per week,” she says. And exercise is equally key. “Don’t make it
difficult. Walk four to five times per week for at least 45 to 60 minutes, and
do light weights for upper-body strengthening. Yoga is great for stretching,
relaxation, concentration and balance.”

If you smoke, stop, as it is linked to an increased
incidence of hot flashes, she points out. “Also include stress-reduction
practices (yoga, mindfulness meditation, tai chi, etc.),” in your regimen, she
says.

Hulem recommends making these simple changes to minimize
incidents. Avoid spicy foods, which can trigger hot flashes. Dress in layers,
so you can peel off outer clothing when you start to feel warm, and keep in
mind that cotton is cooler and more breathable than synthetics. Also avoid
using hair dryers and taking hot showers. Some women also keep a fan on their
desk at work or in their family rooms to get a cool breeze going when they feel
a hot flash coming on.

To stave off night sweats, “avoiding alcohol within two
hours of going to bed is so important,” says Hulem. “Our estrogen levels are at
their lowest at 2 o’clock in the morning, and this is when we will most likely
be awakened with night sweats. Alcohol, while it is metabolizing in our body,
raises our body temperature, so it is a double whammy to have low estrogen
levels and alcohol going on at the same time.”

“If hot flashes are becoming more frequent, then you can
consider over-the-counter products,” says Hulem. “The most effective herbal
options are black cohosh and soy [isoflavone] products.” Both supplements are
available in tablet and capsule form. Although there have been some promising
studies on black cohosh’s effect on menopausal symptoms, including hot flashes,
the National Institutes of Health do not yet officially recommend it.

As for
soy, while previous research had mixed results, a new meta-analysis of 17
previous studies in Menopause: The
Journal of The North American Menopause Society found that women who took
soy isoflavone extracts had a 21 percent reduction in hot flashes compared with women
who took a placebo. The analysis also found that when women did have hot
flashes while taking soy, the hot flashes were less severe.

“If hot flashes are really impacting your day-to-day life,
then talking with your health care provider [about prescription hormone
replacement therapy] is the next step,” she says. “Pharmaceutical options are aplenty today, especially after the bombshell that was dropped by the Women’s Health Initiative
study in 2002,” says Hulem. In 2002, the Data and Safety Monitoring Board of
the Women’s Health Initiative, a large set of clinical trials, identified an
increased risk of breast cancer, heart attacks, strokes and blood clots to the
lungs and legs in women taking hormone replacement therapy. Determining that
the overall risks outweighed the benefits, the Board recommended against taking
hormone replacement therapy for the long term. Now women who do choose to take HRT
take a much lower dose, and only for a few years, just until menopausal
symptoms abate.

“Hormone replacement comes in every imaginable vehicle:
pills, patches, vaginal rings, vaginal tablets, creams, gels, and sprays,”
explains Hulem. “The dose of each hormone is much lower now but still very
effective in reducing the symptoms of hot flashes, night sweats and vaginal
dryness. Pharmaceutical options will work quickly to reduce symptoms (within
two weeks), whereas taking over-the-counter products may take up to six to eight weeks before
you see relief.

There are two types of hormone therapies: bioidentical
hormones (BHRT), which are derived from plants and are chemically identical to those
your body produces; and traditional hormones, which are synthesized chemically
in a lab. But according to the Food and Drug Administration, there’s no
evidence that bioidentical hormones are more effective than traditional hormone therapy.

"FDA is not aware of any credible scientific evidence to support claims made regarding the safety and effectiveness of compounded 'BHRT' drugs. "They are not safer just because they are 'natural,'" says Kathleen Uhl, M.D., Director of FDA's Office of Women's Health, on the FDA website.

But, Hulem warns, “Hormones
are not for every woman. The benefits and risks must be carefully discussed so
that the woman understands her options.”